Pooling of  T3

We are calling this issue Pooling, for lack of a term, as Pooling is not a medical term. Patient experience has shown a free T3 at the top of the range or over range and a free T4 at the bottom of the range WITH hypothyroid symptoms, is an indicator of pooling.  This gets complicated when you add T3 to your Natural Desiccated Thyroid (NDT) or T4, or you are on T4 only, because labs are expected to look like that when optimal on T3. 

In that case, you need to look at your symptoms, are you symptom free from hypo symptoms? Is your temperature at 3 PM optimal at 98.6 or is it low?  What does your heart rate look like, is it the same as usual or is it high or too low for you?  Do you have a feeling of adrenaline rushing, anxiety, racing heart etc.?

If you do indeed have hypo symptoms and or adrenaline rushes, then you are likely pooling.

The two biggest culprits are low/high iron and cortisol issues, but they are not the only things that can cause pooling. Simply having non-optimal vitamins and minerals, food sensitivities, LOW stomach acid (symptoms are the same for HIGH stomach acid!), can cause pooling of the T3.

How do we treat this Pooling of T3??

The first step is to find what has caused this to happen and then begin treating those causes of pooling by ordering a 24- hour saliva cortisol test and all four iron labs, if you can swing testing vitamins and minerals at the same time, by all means do!  Remember, it is about WHERE in the lab range your results fall, not that they fall within the lab range. 

 While we work on discovering why we are Pooling, and then treating the causes, we reduce any T3 containing medications by half or more, allowing the T3 to clear the bloodstream, and allow it to be used.  If you reduce enough, the T3 will clear in one week.  Some have found it may take longer to clear if on NDT only.

Patient experience has shown that after 7 days on the reduced dose of T3, they can begin adding back in very small amounts of T3 only.  For those that were on NDT before pooling, this means a one grain (60 or 65 mg depending on the brand you take) of NDT dose and raising with T3 only to remove those hypo symptoms.

How much is a small amount of T3 weekly? Patient experience has shown that most have success adding in 5 mcg per week (or quartering a 25-mcg pill to get 6.25 mcg if that is your only option). It seems to be best, especially if you have not found all your causes, or treated them to no symptoms, to wait a full 7 days before raising again between each raise of 5 mcg of T3.  If symptoms return sooner than 7 days and are unbearable, you could try raising sooner.  It is extremely important to remember that the Pooling WILL happen again if you are not treating the cause of it.

What about Pooling AND Reverse T3?

Sooner or later, and highly likely if you are using Natural Desiccated Thyroid (NDT) or T4 in your thyroid treatment, Reverse T3 (rT3) will climb high.

rT3 is the inactive hormone that T4 converts to when Iron and or adrenals are not optimal. 

The rT3 contributes to the Pooling since it is likely that the iron is not optimal.

A high FT3 level on labs will also mean your rT3 ratio can look to be optimal, when in fact, it is far from it!

Pooling and Reverse T3 issues do not always happen together.  Some people Pool T3 with no Reverse T3 issues, some people have Reverse T3 issues with no pooling of T3.  Patient experience has shown though, that if you have Iron and or cortisol issues, and continue to raise your NDT or T4 meds the rT3 will continue to rise, leaving you hypo.

Can I prevent pooling and high rT3?

In some cases, yes!  It is SO important to know what these results for iron and adrenals are sooner than later, you can prevent these from happening in some cases, if you know you are not optimal in one or both, before raising NDT past one grain, or raising T3 in higher doses than 5 mcg per week.

To recap testing for causes of pooling:

A saliva cortisol test done four times in the day (the lab you choose needs to have full lab ranges with a bottom and top of range all four times, ZRT and Labrix are two we like) Click here for information regarding Adrenal Testing